Healthcare Provider Details

I. General information

NPI: 1285670901
Provider Name (Legal Business Name): LLOYD STANLEY GOODMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 LEXINGTON AVE
SAVANNAH GA
31404
US

IV. Provider business mailing address

1101 LEXINGTON AVE
SAVANNAH GA
31404-5502
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-7171
  • Fax: 912-350-3454
Mailing address:
  • Phone: 912-350-7171
  • Fax: 912-350-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number013215
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number013215
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: